BackgroundEndoscopic transpapillary pernasal gallbladder drainage and endoscopic
gallbladder stenting (EGS) have recently been reported to be useful in
patients with acute cholecystitis for whom a percutaneous approach is
contraindicated. The aim of this study was to evaluate the efficacy of
permanent EGS for management of acute cholecystitis in elderly patients who
were poor surgical candidates.MethodsWe retrospectively studied 46 elderly patients aged 65 years or older with
acute cholecystitis who were treated at Japan Labour Health and Welfare
Organization Niigata Rosai Hospital. In 40 patients, acute cholecystitis was
diagnosed by transabdominal ultrasonography and computed tomography, while 6
patients were transferred from other hospitals after primary management of
acute cholecystitis. All patients underwent EGS, with a 7Fr double pig-tail
stent being inserted into the gallbladder. If EGS failed, percutaneous
transhepatic gallbladder drainage or percutaneous transhepatic gallbladder
aspiration was subsequently performed. The main outcome measure of this
study was the efficacy of EGS.ResultsPermanent EGS was successful in 31 patients (77.5%) with acute cholecystitis,
without any immediate postprocedural complications such as pancreatitis,
bleeding, perforation, or cholangitis. The most common comorbidities of
these patients were cerebral infarction (n=14) and dementia (n=13). In 30 of
these 31 patients (96.7%), there was no recurrence of cholecystitis and 29
patients (93.5%) remained asymptomatic until death or the end of the study
period (after 1 month to 5 years).ConclusionsEGS can be effective for elderly patients with acute cholecystitis who are
poor surgical candidates and can provide a solution for several years.